Provider Demographics
NPI:1013998830
Name:EPILEPSY & NEUROPHYSIOLOGY MEDICAL CONSULTANTS PA
Entity Type:Organization
Organization Name:EPILEPSY & NEUROPHYSIOLOGY MEDICAL CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANCMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-428-3651
Mailing Address - Street 1:333 WESTCHESTER AVE STE E104
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2930
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-3205
Practice Address - Fax:201-343-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0240982Medicaid
NJ7832508Medicaid
NJ025939Medicare PIN